EHRs May Be Tied to Potential Patient Harm, Study Suggests

Marcia Frellick

March 27, 2018

Use of electronic health records (EHRs) or aspects of the EHRs themselves may be linked to potential patient harm, an analysis of patient safety reports indicates.

The study, by Jessica L. Howe, MA, from the National Center for Human Factors in Healthcare at MedStar Health in Washington, DC, was published online today in JAMA.

The researchers analyzed patient safety reports from 2013 through 2016 from the Pennsylvania Patient Safety Authority database. Safety reports, written voluntarily by healthcare staff (mostly nurses), describe the safety event, contributing factors, what effect the event had on a patient, and whether that effect meant more healthcare services were needed.

Reports were included in the study if one of the top five EHR vendors or products was mentioned and if the provider indicated that the event caused the patient possible harm.

Of 1.735 million reported safety events, 1956 (0.11%) included the name of an EHR vendor or product and were reported as possibly causing patient harm, and 557 (0.03%) contained language "explicitly suggesting" that use of the EHR contributed to possible patient harm.

Of those 557 reports, harm levels were broken into 4 categories, and their occurrences were as follows: potentially required monitoring to prevent harm (84%, n = 468), potentially caused temporary harm (14%, n = 80), potentially caused permanent harm (1%, n = 7), and could have required intervention to save a life or could have resulted in death (<1%, n = 2).

Usability factors were divided into 7 categories, with data entry, alerting, and interoperability more frequently linked to potential harm than others.

Table.

Usability Category Number of Events Events, %
Data entry 152 27
Alerting 122 22
Interoperability 102 18
Visual display 52 9
Information accessibility 50 9
System automation/defaults 43 8
Workflow support 36 7

The researchers also tracked when EHR usability problems occurred, and found that most occurred in order placement (38%) or when giving medication (37%), followed by reviewing results (16%) and documentation (9%).

The authors note the study has limitations: "Patient safety reports contain limited information making it difficult to identify causal factors and may be subject to reporter bias, inaccuracies, and a tendency to attribute blame for an event to the EHR," they write.

They also say that although only a small percentage of potential harm events were linked to EHR usability, the numbers may be conservative because the incidents reported are only a fraction of the events that happen and the study only included reports that mentioned specific vendors or products.

This project was funded by the Agency for Healthcare Research and Quality of the US Department of Health and Human Services. The authors have disclosed no relevant financial relationships.

JAMA. Published online March 27, 2018.

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